Once You Are HomeWednesday, April 18, 2012 - 16:55
Once you are discharged from the hospital, a nurse, physical therapist, and possibly an occupational therapist will likely see you for in-home treatment. This is to ensure your are safe in and about your home.
Home health varies from one to several visits for a safety check and review of an exercise program. In some cases, it may require up to three visits before beginning outpatient physical therapy. In other cases, the individual may be functioning adequately with his or her total knee replacement and may not require outpatient therapy.
The home exercise program is often similar to the hospital program with the progression of resistance and repetitions of strengthening exercises and increased distance and independence of ambulating.
The occupational therapist involved in the home health care of the postoperative total knee patient closely examines how safely and independently the patient is able to dress, bathe, and care for his or herself within the home environment.
Outpatient Physical Therapy
Once no longer homebound following surgery, most medical insurance will no longer provide financial coverage for home health. If a need for additional rehabilitation has been determined, outpatient physical therapy may be the next option. A new evaluation is generally conducted at the out-patient facility with new goals of rehabilitation determined at that time.
In an out-patient physical therapy clinic the physical therapist may use the following methods of treatment to help reduce persistent swelling or pain:
Thermotherapy Or Cryotherapy (use of heat or ice)
Electrical stimulation Ultrasound
- Hydrotherapy (whirlpool or pool)
Progression Of Walking And Exercise
Continued use of a walker or crutches is commonplace in an outpatient setting. However, the goal is generally to progress to walking without an assistive device if possible. Depending on the surgical procedure, the physical therapist will instruct the progression of weight bearing on the surgical leg as follows:
If A Cemented Procedure Was Used:
The progression following surgery will be from using a walker, to crutches, to a cane, and concluding with independent walking with no help as tolerated.
If A Non-Cemented Procedure Was Used:
The postoperative patient may be instructed to be toe-touch only until a follow-up x-ray and/or the physician recommends to advance the amount of weight bearing (usually by the fifth or sixth week postoperatively).
Increasing the post operative patient's endurance can be addressed through lap swimming, and using upper body exercises. The physical therapist will select a group of exercises that can be used to simulate day-to-day activities, like going up and down steps, squatting, raising up on the toes, and bending down.
Once the goals have been met in an outpatient setting regarding range of motion of the knee, strength, endurance, and ability to walk independently, the patient is ready for discharge with an independent program.